Duct ectasia
Duct ectasia is a benign breast condition characterized by the blockage and inflammation of the mammary milk ducts, which can lead to fluid accumulation. It is particularly common among women in their forties to fifties, especially those experiencing perimenopause or menopause. Risk factors include a history of periductal mastitis, cigarette smoking, inverted nipples, and having multiple pregnancies, with hormonal changes and vitamin A deficiency also playing a role in its development.
Symptoms may manifest as a breast lump, infection signs like redness and swelling, and varying types of nipple discharge. Diagnosis typically involves physical examinations, imaging tests such as mammography and ultrasound, and sometimes a ductogram to exclude other conditions like ductal carcinoma in situ (DCIS). Treatment usually includes antibiotics and supportive care, such as warm compresses and a supportive bra, while surgical intervention is rare. While duct ectasia is not preventable and does not increase breast cancer risk, recovery is typically complete, although some women may experience recurrent episodes.
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Subject Terms
Duct ectasia
ALSO KNOWN AS: Plasma cell mastitis, mastitis obliterans, comedomastitis, secretory disease of the breast
RELATED CONDITIONS: Periductal mastitis
DEFINITION: Duct ectasia is a benign condition in which the mammary milk ducts (small tubes that carry breast milk to the nipple) fill with fluid and become plugged and inflamed.
Risk factors: Duct ectasia is more common in women with a history of periductal mastitis (infection of the breast ducts), cigarette smoking, an inverted nipple, and more than one pregnancy. The hormonal changes that occur with aging increase a woman’s risk of developing duct ectasia, as does a lack of vitamin A.
Etiology and the disease process: Duct ectasia appears to start with an inflammatory process (the body’s response to irritation or injury), similar to an infection. A duct fills with fluid from the blood plasma, lymph, and circulatory systems. Lipids (fatty substances) and dead cells block the fluid from draining and lead to fluid buildup in the duct. This causes the duct to dilate and become hardened.
Incidence: Duct ectasia typically develops in women who are in their forties or fifties and are in perimenopause or menopause.
Symptoms: Duct ectasia may appear as a lump in the breast or as an infection, marked by redness, swelling, pain, hardness, and fever. There may be a nipple discharge that is tan, white, greenish, or black. Sometimes, the nipple is inverted.
Screening and diagnosis: Duct ectasia is diagnosed by physician examination of the nipple discharge, breast self-examination, mammography, or breast ultrasound. Although the symptoms usually provide the necessary information for diagnosing duct ectasia, in some instances, it may be necessary to the affected area of the breast. Sometimes, a ductogram is also performed to rule out ductal carcinoma in situ (DCIS).
Treatment and therapy: The treatment for duct ectasia usually involves medication. The patient is given an antibiotic based on the culture and sensitivity of the nipple discharge. New medications that reduced inflammatory pathways were under investigation in the mid-2020s. Warm, moist compresses are applied to the affected breast area three to four times a day for ten to fifteen minutes. The patient should wear a supportive bra and sleep on the unaffected side. In rare instances, it is necessary to incise (surgically open) and drain the infected duct.
Prognosis, prevention, and outcomes: There is no method for preventing duct ectasia. Because duct ectasia is a benign problem, recovery is generally complete. Some women do have multiple incidences of duct ectasia. This condition does not increase a woman’s risk of developing breast cancer.
Bibliography
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